HR 3321119th CongressIntroduced

Ending Medicaid Discrimination Against the Most Vulnerable Act

Introduced: May 9, 2025

HealthcareSocial Services

Standard Summary

Comprehensive overview in 1-2 paragraphs

This bill, titled the Ending Medicaid Discrimination Against the Most Vulnerable Act, would gradually eliminate the enhanced federal match (FMAP) that currently funds a larger share of Medicaid costs for low‑income adults who are covered under the program. It amends the Social Security Act to implement a phased reduction from 2027 through 2034, with the enhanced match ending by 2035 and standard FMAP rules resuming thereafter. The plan ties the annual reduction to a state-specific calculation based on each state's 2026 FMAP, and provides rules that distinguish between expansion and non-expansion states. In addition, the bill would remove a temporary FMAP increase for states that begin to cover low‑income adults and introduces state options around how to handle ACA expansion populations (the adults earning up to 138% of the federal poverty line). Overall, this proposal would reduce federal Medicaid support for low‑income adults over time and give states more discretion about expanding or restricting coverage, potentially increasing state costs and affecting coverage for vulnerable adults.

Key Points

1Phase-out schedule: Starting in 2027, the bill gradually reduces the enhanced FMAP for Medicaid-covered low‑income adults in each state, with reductions continuing through 2034, and the enhanced match ending in 2035, after which standard FMAP would apply without the enhancement.
2State‑level reduction formula: For each state, the annual reduction equals a calculated number of percentage points (the difference between 90% and the state’s 2026 FMAP, divided by 8). The applicable FMAP for 2027–2034 is the prior year’s rate minus this per-year reduction, subject to a floor determined by the state’s standard FMAP (if higher).
3Post-2024 rules for expansion vs. non-expansion states: The bill creates different rules after 2024 for states that have expanded Medicaid under the ACA versus those that have not. Non-expansion states are generally excluded from paragraph (1)’s phase-out, while expansion states face options to manage their expansion populations under the new FMAP framework.
4Expansion population options: Expansion states may elect to cover only newly eligible individuals up to certain income limits (e.g., 100% of the federal poverty line) while continuing to receive FMAP for those amounts, or may continue broader coverage depending on state choices.
5Elimination of temporary FMAP increase: The bill repeals the temporary FMAP increase for states that begin to provide medical assistance to low-income adults, effectively removing that extra federal support.

Impact Areas

Primary group/area affected: Low‑income adults covered by Medicaid (including those in ACA expansion populations) who would see a staged reduction in the federal share of Medicaid costs from 2027 through 2034, with a return to standard FMAP by 2035.Secondary group/area affected: States (expansion and non-expansion) and their budgets, as well as state decisions about expanding or limiting coverage for adults under 1902(a)(10)(A)(i)(VIII). Healthcare providers and plans that rely on Medicaid funding may also be affected by changes in reimbursement levels and coverage.Additional impacts: Potential changes in eligibility practices, coverage levels, and benefits for low-income adults; changes in federal spending on Medicaid; possible shifts in state fiscal pressures and service delivery choices as the enhanced federal match is phased out.FMAP = Federal Medical Assistance Percentage, the federal share of Medicaid costs for each state.The bill’s language distinguishes between expansion states (those that expanded Medicaid under the ACA) and non-expansion states, and includes options for how states manage expansion populations in light of the phased-out enhanced match.

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